Healthcare Provider Details

I. General information

NPI: 1710635818
Provider Name (Legal Business Name): IVAN JOEL GARAY O'FERRALL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2022
Last Update Date: 03/17/2022
Certification Date: 03/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CONDOMINIO LOS NARANJALES APT 274
CAROLINA PR
00985
US

IV. Provider business mailing address

CONDOMINIO LOS NARANJALES APT 274
CAROLINA PR
00985
US

V. Phone/Fax

Practice location:
  • Phone: 787-930-6739
  • Fax:
Mailing address:
  • Phone: 787-930-6739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number9073
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: